The usefulness of His bundle pacing in a heterogeneous population of patients with impaired left ventricular systolic
Rafal Gardas1,2, Krzysztof S Golba3,4, Danuta Loboda3,4
1Department of Electrocardiology and Heart Failure, Medical University of Silesia, Katowice, Poland. rafal.gardas@gmail.com.
Insights
His bundle pacing improves heart function in patients with reduced ejection fraction. This study shows His bundle pacing normalizes QRS duration and leads to significant improvements in left ventricular ejection fraction and reverse remodeling.
Area of Science:
- Cardiology
- Electrophysiology
- Cardiac Pacing
Background:
- His bundle pacing (HBP) preserves physiological ventricular activation.
- It can normalize wide QRS duration in patients with intraventricular conduction delay (IVCD).
Purpose of the Study:
- To evaluate the effectiveness of His bundle pacing in patients with reduced left ventricular ejection fraction (LVEF).
- To assess the impact of HBP on ventricular remodeling and pacing parameters.
Main Methods:
- 181 patients with LVEF < 50% were enrolled in the study.
- Indications for HBP included bradycardia, IVCD with resynchronization indication, or pacing-induced cardiomyopathy.
- Pacing parameters, echocardiographic, and clinical data were assessed up to 24 months.
Main Results:
- His bundle pacing was successful in 85.1% of patients.
- At 6-month follow-up, LVEF improved from 35.3% to 43.1% (p < 0.0001).
- Indexed left ventricular end-systolic volume decreased significantly, with 53.1% showing >15% reduction.
Conclusions:
- His bundle pacing improves LVEF in permanently paced patients with reduced ejection fraction.
- HBP is associated with reverse left ventricle remodeling.
Background:
His bundle pacing (HBP) maintains a physiological activation pattern of ventricular activation, and in patients with intraventricular conduction delay (IVCD) it can normalize wide QRS duration.
Methods:
A total of 181 patients from the HBP registry were enrolled into a the study, which was conducted at the Department of Electrocardiology in Katowice, Poland. The patients had left ventricular ejection fraction (LVEF) < 50% and were implanted between November 2015 and April 2019. The HBP indications were as follows: 1) bradycardia and atrioventricular conduction disturbances with expected high pacing burden, 2) IVCD, LVEF ≤ 35%, with an indication for resynchronization therapy, 3) the need to upgrade to resynchronization therapy due to pacing-induced cardiomyopathy. Pacing parameters and echocardiographic and clinical data were assessed for up to 2 years of follow-up (FU).
Results:
His bundle pacing was successful in 154 (85.1%) patients. Eighty-two patients completed a 6-month FU. The mean age was 70.6 ± 9.23 years, and 79% were males. At 6 months FU LVEF improved from 35.3 ± 8.22% to 43.1 ± 10.14% (p < 0.0001), and indexed left ventricular end-systolic volume (LVESVi) decreased from 63.1 ± 25.21 mL/m² to 51.9 ± 22.79 mL/m² (p < 0.0001). In 53.1%, the LVESVi reduction was greater than 15%. The improvement in LVEF and LVESVi was also observed after 24 months of FU.
Conclusions:
His bundle pacing in permanently paced patients when LVEF is reduced below 50% is associated with improvement in LVEF and reverse left ventricle remodeling.
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